Classics revisited. Raissa Nitabuch, on the uteroplacental circulation and the fibrinous membrane
Introduction
In the late 19th century Raissa Nitabuch together with a group of female students came from Russia to Switzerland to study medicine. After graduation from the University of Zürich, she moved to Bern, where at the Institute of Anatomy she did a doctoral thesis entitled “Kenntniss der menschlichen Placenta”, which as “Inaugural Dissertation” of the University of Bern appeared in print in 1887, Fig. 1 [1].
The mentor of Raissa Nitabuch was Professor Theodor Langhans, whose name is known to placentologists, since he first described the cytotrophoblast [2]. Under his direction, research activities at the Institute of Anatomy at the University of Bern focussed on different topics of placentology such as characterisation of the trophoblast as well as the distribution of fibrinous material at different locations inside the placenta and decidua. This led to several publications on important contributions, which appeared in those years. In her doctoral thesis, Raissa Nitabuch first described a fibrinous layer in the decidua as the region, where after delivery of the baby the placenta detaches from the uterine wall. Up to this day, this layer is known as “Nitabuch membrane”.
In the introduction, she describes the anatomical connection of the intervillous space with the maternal vasculature as the main objective of that study. In hindsight, the decidual fibrin layer is just an accidental finding. This dissertation is the first printed document with a detailed description of spiral arteries as the link between the intervillous space and the uterine vasculature. In view of the enduring scientific dispute about the uteroplacental circulation carried out in the late nineteenth and early twentieth century, it remains unclear, why the significance of this important finding at the time was not recognised.
Herein we outline the context of this discovery, which deserves belated appreciation as a classic.
Section snippets
Early indications for circulation of maternal blood inside the placenta
Already in the 18th century, Albrecht von Haller a famous scholar from Bern had postulated with respect to the connection between the uterus and the placenta, that some maternal blood reaches the placenta [3]. A few years later, William Hunter wrote: «Notwithstanding the disputes still subsisting among anatomists, whether any blood vessels pass between the uterus and placenta, and though the texture of these vessels be so exceedingly tender that they break with the least force, they are as
Preparation
The study was based on an autopsy specimen, which came from a woman, who had died from tuberculous meningitis at the age of 21. At the time of death, she was 6 months pregnant. At autopsy, the pregnant uterus was carefully removed. After four months fixation in absolute alcohol, the uterus and its contents by a frontal cut were divided into an anterior and posterior half showing a perfectly hardened foetus with its membranes. There is no mention of the implantation site of the placenta or the
Re-appraisal of the findings of the late 19th century in the perspective of the 21st century
From the findings by Raissa Nitabuch it was quite clear, that there is no capillary system as part of the maternal circuit of the placenta. The forces involved in “shortcutting” the flow of blood through the villous system were unclear at the time. Only decades later, issues of flow dynamics were addressed [12], [13]. However, the full understanding of rheology and regulation of maternal blood flow inside the intervillous space even today remains incomplete. In 1893 just a few years after the
Acknowledgements
We thank Hubert Steinke, director of the Institute of History of Medicine, University of Bern who gave us access to documents of the archives of the Institute and provided valuable comments. Pia Burkhalter and Bruno Müller of the Institute of History of Medicine helped to locate some of the historical documents.
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Cited by (11)
Failure of placental detachment in accreta placentation is associated with excessive fibrinoid deposition at the utero-placental interface
2022, American Journal of Obstetrics and GynecologyCitation Excerpt :Fewer than half of the published clinical cohorts on prenatal diagnosis or management of PAS lack histopathologic confirmation of the diagnosis and grading11,12; thus, our understanding of the pathophysiology of the different grades of PAS remains limited. In 1887, Raissa Nitabuch was the first to describe the anatomy of the decidual layers and to identify the spiral arteries.13 Although her findings were based on only 1 case, the continuous fibrinoid layer or stria that is laid down between the trophoblastic cell columns of the anchoring villi and uterine decidual cells is still known as the Nitabuch membrane.
Classics revisited: Anna Reinstein-Mogilowa's observations on uterine glands and the cytotrophoblastic shell in the first trimester of human pregnancy
2020, PlacentaCitation Excerpt :Like Julia Brinck and Edith Pechey-Phipson, their desire was to practise medicine. Nothing is known of the subsequent career of Nitabuch [28]. However, Chaletzky or Eva Haljecka Petković (Serbian transliteration) completed her training in Vienna under Friedrich Schauta (1849–1919), became the first female gynaecologist in the Balkans, and was an activist for equal rights for women doctors [1,2,19].
Placental bed research: I. The placental bed: from spiral arteries remodeling to the great obstetrical syndromes
2019, American Journal of Obstetrics and GynecologyCitation Excerpt :She observed in the decidua the presence of a fibrinous layer that in her view was the site of detachment of the placenta from the uterine wall after the baby’s delivery. Since then, this fibrinous layer has been coined the Nitabuch membrane, although the findings of this investigation were never published.61 The significance of this layer was discussed more than 50 years ago by Bădărău and Gavriliţă,62 who believed that “the striae of Rohr, Nitabuch, and Langhans” made biological sense, constituting a peripheral fibrinoid barrier capable of arresting the trophoblast’s “invasive proliferation by the same general process of cellular necrosis.”